Clinical lung cancer · 2026
Impact of Consolidation Durvalumab on Local Control Following Chemoradiotherapy for Non-Small Cell Lung Cancer.
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Zakharia Adel, Bodner William, Halmos Balazs, Garg Madhur, Gucalp Rasim, Cheng Haiying, Stiles Brendon, Ohri Nitin
Аннотация
BACKGROUND: The PACIFIC trial demonstrated that durvalumab after concurrent chemoradiotherapy (CCRT) improves survival in locally advanced non-small cell lung cancer (NSCLC), but its impact on in-field local control is unclear. We reviewed outcomes with and without consolidation durvalumab to evaluate its effect on local control of treated tumors and lymph nodes.
PATIENTS AND METHODS: We reviewed patients with locally advanced NSCLC who underwent staging FDG-PET and CCRT with or without consolidation durvalumab between 2007 and 2023. Patients with progression or death within 6 weeks postradiotherapy were excluded. Lesions were categorized as high- or low-risk using a volume cutoff of 25 cc. Kaplan-Meier and competing risks analyses were used to evaluate progression-free survival (PFS), overall survival (OS), and local progression. Tumor control probability (TCP) modeling was performed to characterize the association between lesion volume and local control.
RESULTS: Among 233 patients with 696 irradiated lesions, 88 patients (38%) received durvalumab. Median follow-up was 70 months overall and 44 months with durvalumab. Durvalumab receipt was associated with improved PFS (median 16 vs. 11 months, P = .011) and improved OS (median 50 vs. 30 months, P = .042). Durvalumab was not significantly associated with local recurrence rate on a patient level (2-year recurrence rate 12% vs. 17%, P = .361). At the lesion level, the 2-year recurrence rate was 6% overall, and high-risk lesions had greater recurrence risk (19% vs. 2%, P < .001).
CONCLUSIONS: Many patients with LA-NSCLC have little risk of in-field recurrence after chemoradiotherapy, with or without consolidation durvalumab. Bulky lesions remain prone to failure, highlighting the need for improved local control strategies in high-risk disease.
PATIENTS AND METHODS: We reviewed patients with locally advanced NSCLC who underwent staging FDG-PET and CCRT with or without consolidation durvalumab between 2007 and 2023. Patients with progression or death within 6 weeks postradiotherapy were excluded. Lesions were categorized as high- or low-risk using a volume cutoff of 25 cc. Kaplan-Meier and competing risks analyses were used to evaluate progression-free survival (PFS), overall survival (OS), and local progression. Tumor control probability (TCP) modeling was performed to characterize the association between lesion volume and local control.
RESULTS: Among 233 patients with 696 irradiated lesions, 88 patients (38%) received durvalumab. Median follow-up was 70 months overall and 44 months with durvalumab. Durvalumab receipt was associated with improved PFS (median 16 vs. 11 months, P = .011) and improved OS (median 50 vs. 30 months, P = .042). Durvalumab was not significantly associated with local recurrence rate on a patient level (2-year recurrence rate 12% vs. 17%, P = .361). At the lesion level, the 2-year recurrence rate was 6% overall, and high-risk lesions had greater recurrence risk (19% vs. 2%, P < .001).
CONCLUSIONS: Many patients with LA-NSCLC have little risk of in-field recurrence after chemoradiotherapy, with or without consolidation durvalumab. Bulky lesions remain prone to failure, highlighting the need for improved local control strategies in high-risk disease.